| Shane Charles Wilson, DO | |
|
450 E Sigler Ave, Ste A, Memphis, MO 63555-1726 | |
| (660) 465-2828 | |
| (660) 465-2956 |
| Full Name | Shane Charles Wilson |
|---|---|
| Gender | Male |
| Speciality | Internal Medicine |
| Experience | 14 Years |
| Location | 450 E Sigler Ave, Memphis, Missouri |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477808467 | NPI | - | NPPES |
| 1477808467 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 2014026613 (Missouri) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Scotland County Home Health Agency | Memphis, MO | Home health agency |
| Scotland County Hospital | Memphis, MO | Hospital |
| Blessing Hospital | Quincy, IL | Hospital |
| Northeast Regional Medical Center | Kirksville, MO | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Northeast Missouri Health Council Inc | 1658280805 | 19 |
| Entity Name | Northeast Missouri Health Council Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1881730893 PECOS PAC ID: 1658280805 Enrollment ID: O20040107000173 |
| Entity Name | Northeast Missouri Health Council Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1104829498 PECOS PAC ID: 1658280805 Enrollment ID: O20040112000061 |
| Entity Name | Scotland County Memorial Hospital |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1205844982 PECOS PAC ID: 8224940366 Enrollment ID: O20040923000249 |
| Entity Name | Scotland County Memorial Hospital |
|---|---|
| Entity Type | Part A Provider - Critical Access Hospital |
| Entity Identifiers | NPI Number: 1083624647 PECOS PAC ID: 8224940366 Enrollment ID: O20140226001733 |
| Mailing Address | Practice Location Address |
|---|---|
| Shane Charles Wilson, DO 450 E Sigler Ave, Ste A, Memphis, MO 63555-1726 Ph: (660) 465-2828 | Shane Charles Wilson, DO 450 E Sigler Ave, Ste A, Memphis, MO 63555-1726 Ph: (660) 465-2828 |
Dr. Robert Wayne Jackson, D.O. Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: Sigler Ave, Memphis, MO 63555 Phone: 660-465-2828 Fax: 660-465-2820 |